News highlights on health security threats and countermeasures curated by Global Biodefense
This week’s selections include plans to unveil a new comprehensive U.S. National Biodefense Strategy; vaccination and surveillance efforts for rising human monkeypox cases; and pigs as amplifying hosts for a long list of new and emerging zoonotic viruses.
POLICY + GOVERNMENT
WHO to Convene Emergency Committee on Monkeypox Spread
The unprecedented geographic expansion of the virus means there may be a need for a coordinated international response, Director-General Tedros Adhanom Ghebreyesus said as he announced he had called a meeting of a so-called emergency committee for June 23. As of today, there have been more than 1,700 confirmed and suspected cases of monkeypox reported from four dozen countries where the virus is not typically found. In the United States, 17 states and the District of Columbia have reported 65 cases. STAT
Biden to Unveil Plan for Next Pandemic While Seeking $88 Billion in Funds
As soon as this month, the administration is expected to release a National Biodefense Strategy that will outline its approach to facing biological threats to humans, animals, environments and crops, according to people familiar with the matter. The plan, along with $88.2 billion in funding the president is seeking, would shift how the government handles pandemic preparedness by more clearly describing responsibilities, goals and deadlines — an attempt to avoid the confusion and agency infighting that plagued the US pandemic response. The new National Biodefense Strategy builds on Biden’s previously released American Pandemic Preparedness Plan and his request in the 2023 budget for $88.2 billion in mandatory funding for biodefense purposes, which, if approved by Congress, would be made available over five years. People familiar with the strategy suggested that Biden’s plan still isn’t specific enough about which agencies and sub-units would be responsible for certain tasks and would require tens of billions of dollars of investment to back its ideas. Bloomberg
USDA Responds to Increasing Demands of Avian Flu Outbreak
Highly pathogenic avian influenza (HPAI) requires a rapid response because it is highly contagious and often fatal to poultry. The virus has been confirmed in 35 states, affecting more than 37.9 million domestic birds. To help ensure that the USDA Animal and Plant Health Inspection Service (APHIS) can continue to perform its response activities, Secretary of Agriculture Vilsack has approved the transfer of $400 million from the Commodity Credit Corporation to APHIS. Vilsack had previously approved about $130 million in emergency funding in March, along with an additional $263 million in April. USDA APHIS, The Daily Intake
Another Disaster: The Closing of the National Library of Medicines Disaster Information Management Research Center
As part of a broader reorganization, the NIH Disaster Information Management Research Center (DIMRC) website was discontinued in 2021, dispersing a decades-long centralized resource. Disaster Medicine and Public Health Preparedness
The following resources moved or will be moving to other agencies and organizations:
- NIH Disaster Research Response (DR2) moved to the National Institute of Environmental Health Sciences.
- Disaster Information Specialization moved to the Medical Library Association.
- Chemical Hazards Emergency Medical Management (CHEMM) has moved to HHS.
- Radiation Emergency Medical Management (REMM) has moved to HHS.
Many of the original sources for disaster-related information from the Disaster Information Management Resource Center (DIMRC) website and the Disaster Lit database can be found at:
- CDC Emergency Preparedness and Response website
- ASPR Public Health Emergency website
- ASPR Technical Resources, Assistance Center, and Information Exchange (TRACIE) website
FDA Radiation Sterilization Pilot Program to Counter Supply Chain Problems
The FDA announced it is considering a master file pilot program for premarket approval holders whose approved devices are sterilized using radiation, including gamma radiation, due to global supply chain constraints and to support sterilization supply chain resiliency. If implemented, this program would help medical device manufacturers advance alternative ways to sterilize their approved medical devices, including changing radiation sources, in a least burdensome regulatory approach. The FDA is working with sterilization experts, medical device manufacturers, and other government agencies to advance alternative ways to sterilize medical devices, including using lower levels of currently used sterilizing agents and using new sterilizing agents or alternatives, while maintaining device safety and effectiveness. FDA
Preliminary Report for the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO)
This first report focuses on providing initial recommendations for the development of a global framework to study emerging and re-emerging pathogens of pandemic potential and preliminary recommendations on urgent studies needed to better understand the origins of the COVID-19 pandemic. The report provides background information about the formation and meetings of the SAGO since it was established on 13 October 2021, including an overview of some of the scientific discussions members have had in plenary and as part of technical working groups of the SAGO. The second version of the report includes a timeline, letters to WHO from the SAGO, and clarifications requested by WHO. World Health Organization
MEDICAL COUNTERMEASURES
Medical Countermeasure Development for Certain Serious or Life-Threatening Conditions
The Department of Health and Human Services’ (HHS) Food and Drug Administration (FDA) established the Animal Rule in 2002 to allow for the approval of medical countermeasures based on animal efficacy studies when human clinical trials are not ethical or feasible. Medical countermeasures are medical products that may be used to prevent, treat, or mitigate potential health effects of exposure to chemical, biological, radiological, and nuclear (CBRN) agents. GAO found that FDA has undertaken efforts to provide information and feedback to developers to support medical countermeasure development under the Animal Rule. For example, in 2015 FDA issued guidance clarifying the types of studies and data needed to demonstrate product efficacy. FDA has approved 16 medical countermeasures under the Animal Rule, 14 of which were approved over the past decade.
FDA established the Animal Model Qualification Program in 2011 to provide publicly available animal models to support efficacy testing under the Animal Rule for multiple medical countermeasures for a given disease or condition. Researchers and developers can submit models to the program for qualification, and, once qualified, a model can be used by other developers when appropriate. For example, an animal model for inhalation anthrax would include protocols, such as exposure timing and dosage, to produce disease manifestations that adequately reflect inhalation anthrax manifestations in humans. As of April 2022, FDA has qualified one animal model under the program. FDA officials and many developers GAO spoke with attributed the limited number of qualified models to a lack of an incentive to pursue qualification. Specifically, submitting a model for qualification is voluntary, and FDA officials said the qualification process is rigorous and resource intensive, which may deter submissions. However, many developers reported that the limited number of qualified animal models has not impeded product development, citing other ways to identify animal models that can be used for product development. FDA officials and others that GAO spoke with, including some developers and contract research organizations, said the program may still be beneficial. For example, FDA officials said the program could help further future development of medical countermeasures, particularly for CBRN agents that currently do not have approved medical countermeasures. GAO
F.D.A. Panel Recommends Pfizer and Moderna Vaccines for Youngest Children
The only Americans still not eligible for coronavirus vaccines — babies, toddlers and preschoolers — appear on the verge of finally getting cleared to receive them after an advisory panel to the Food and Drug Administration voted unanimously on Wednesday to recommend the Pfizer and Moderna vaccines for the group. The C.D.C.’s own panel of vaccine experts is set to take up the matter over two days this weekend. If that committee also gives a favorable recommendation, Dr. Rochelle P. Walensky, the agency’s director, would issue her decision, the final step in the process. New York Times
Immune Boosting by B.1.1.529 (Omicron) Depends on Previous SARS-CoV-2 Exposure
While it is known that cross-reactive antibody recognition is compromised by the mutations in B.1.1.529 (Omicron), it was surprising that this was so profoundly exacerbated by differential imprinting in those having had prior infection with either Wuhan Hu-1 or B.1.1.7 (Alpha). This adds an important dimension to global control of B.1.1.529 (Omicron) in light of the impact B.1.1.7 (Alpha) has had on the global pandemic: by May 2021 B.1.1.7 (Alpha) accounted for 67% of all cases across 149 countries. That previous SARS-CoV-2 infection history can imprint such a profound, negative impact on subsequent protective immunity is an unexpected consequence of COVID-19. While the notion that, generally, hybrid priming by infection and vaccination enhances immunity is widely agreed, imprinted patterns such as the specific combination of vaccination with infection during the first ancestral Wuhan Hu-1 wave followed by the B.1.1.529 (Omicron) wave requires an additional term — “hybrid-immune-damping.”
These studies have shown that the high global prevalence of B.1.1.529 (Omicron) infections and reinfections likely reflects considerable subversion of immune recognition at both the B, T cell, antibody binding and nAb level, although with considerable differential modulation through immune imprinting. Some imprinted combinations, such as infection during the Wuhan Hu-1 and Omicron waves, confer particularly impaired responses. Science
Gepotidacin is Efficacious in a Nonhuman Primate Model of Pneumonic Plague
Mortality rates from infection with Yersinia pestis are nearly 100% without treatment. Jakielaszek et al. now show that the triazaacenaphthylene antibacterial compound gepotidacin is active against a variety of Y. pestis strains in vitro, including strains resistant to other antibacterial agents. The authors demonstrate that gepotidacin is efficacious in a well-characterized, inhalational model of pneumonic plague in nonhuman primates at gepotidacin exposures that have been achieved in humans. Science Translational Medicine
Developing a Recombinant Butyrylcholinesterase Medical Countermeasure for Organophosphorus Poisoning
Plasma derived human butyrylcholinesterase (huBChE) is a promising novel bioscavenger Medical Countermeasure (MCM) strategy for chemical threats, but is prohibitively expensive to isolate from human plasma at scale. Efforts to produce recombinant huBChE (rBChE) in various protein expression platforms have failed to achieve key critical attributes of huBChE such as circulatory half-life. These proteins often lack critical features such as tetrameric structure and requisite post-translational modifications. This review evaluates previous attempts to generate rBChE and assesses recent advances in mammalian cell expression and protein engineering strategies that could be deployed to achieve the required half-life and yield for a viable rBChE MCM. Whilst challenges remain, a combinatorial approach of these strategies demonstrates potential as a technically feasible approach to achieving a bioactive and cost effective bioscavenger MCM. Chemico-Biological Interactions
How Much Medicine Does the U.S. Actually Have to Fight Monkeypox?
The government has 36,000 doses of the newest smallpox vaccine, made by Bavarian Nordic, on hand, with another 36,000 on the way this week, the pandemic office of the federal health department said. It’s a two-dose regimen, so that’s enough to vaccinate 36,000 people total. Those numbers are only what the federal government immediately has in its possession, and don’t reflect the full scale of the possible response, an administration official said. Ultimately, Bavarian Nordic has another 1 million doses that are owned by the United States and could be shipped, and supply for another more than 16 million doses that could be made into final vaccines. The vaccine, named Jynneos, is the only vaccine that the FDA has officially cleared for use against monkeypox.
Separately, the government also has 100 million of an older smallpox vaccine owned by Emergent BioSolutions immediately on hand, as well. But the public numbers don’t add up to the Biden administration’s statement in May that “the Strategic National Stockpile holds enough smallpox vaccine to vaccinate the entire U.S. population in the event of a smallpox emergency or monkeypox emergency.” STAT
BIOSECURITY + BIOPREPAREDNESS
HHS Screening Framework Guidance for Providers and Users of Synthetic Oligonucleotides, Summary of Updates in Response to Public Comments Received in 2020
HHS collected stakeholder responses to a 2020 Federal Register Notice titled Review and Revision of the Screening Framework Guidance for Providers of Synthetic Double-Stranded DNA and undertook a deliberative process with its interagency colleagues to propose updates to the Guidance. In 2022, the revised guidance was published as a Federal Register Notice, titled Screening Framework Guidance for Providers and Users of Synthetic Oligonucleotides to solicit feedback on
these proposed updates on the 2010 Guidance. This document is a summary of how stakeholder comments from 2020 elicited certain considerations and outlines the justification for the updates.
Most stakeholder responses agreed on extending the scope beyond the Federal Select Agent Program (FSAP) and Export Administration Regulations’ Commerce Control List (CCL) agents. However, some commenters also mentioned that if the scope were expanded, there may also be negative impacts, including increased cost/burden of screening and potential negative effects on research and the bioeconomy. Responses centered on methods to define sequences of concern (SOCs) in a manner that enables consideration of sequences that may pose biosecurity risks, but that are not included in the FSAP and CCL lists. ASPR
The Rapidly Expanding Need for Biosecurity by Design
The advent of biodesign capabilities, such as gene editors, gene synthesis capabilities, and genetic engineering, requires a reevaluation of traditional biosecurity policies to mitigate risks associated with such engineering of biological entities. Here, features of “Biosecurity by Design” approaches are described, including the application of risk/benefit analysis and risk mitigation, post-COVID opportunities, and ethical global norms in the progression of biodesign and growing bioeconomies. BioDesign Research
Russian Aggression Underscores the U.S. Need for Greater Investment in Medical Countermeasures
So far, the U.S. FDA has approved 62 different medical countermeasures resulting from Project BioShield. Some of the most exciting examples include sargramostim (Leukine), a treatment for acute radiation syndrome, and Silverlon, the first approved countermeasure for treating burns caused by mustard gas. Another is obiltoxaximab (Anthim), a monoclonal antibody used to treat anthrax infection. Even Moderna’s Covid-19 vaccine platform, Spikevax, was supported by BARDA. But despite these success stories, America’s CBRN readiness is a decidedly mixed bag. When it comes to responding to threats, the past few years have provided a worrisome case study. The Strategic National Stockpile is an important source of essential medical supplies during a pandemic or CBRN attack. But just weeks after Covid-19 arrived in the United States, the pandemic depleted the stockpile’s inventories of ventilators, masks, and gowns. STAT
Biology’s Tectonic Shifts and Novel Risks
Driven by digital technologies and commercial processes, the field of biology has fundamentally evolved, with widespread implications for war and peace. Biology’s trajectory resembles the advancement of computer software and hardware during the 20th century, making the tools to manipulate life open and accessible. Today, it is easy to read (DNA sequencing), write (DNA synthesizing), alter (gene editing), and share (via the internet) genetic code. Addressing biosecurity requires expertise in computer science, data analysis, and artificial intelligence. Bioterrorism with known agents remains a concern, but the greater threat will be novel risks from trained insiders, unethical tinkerers, and state-sponsored proxies. CTC Sentinel
Implications of the Pandemic for Terrorist Interest in Biological Weapons
Although the prospect of the IS and al-Qaeda pursuing biological weapons is not zero, it is unlikely, given both the difficulties and the much easier and readily available alternatives that meet their objectives. In the wake of the pandemic, several measures can enhance capabilities to address both public health and military challenges. These measures reduce the possibility of and improve the response to a future naturally occurring pandemic while also helping to deter, prevent, and respond to any possible terrorist acquisition and use of biological weapons. Focusing unduly on the potential, but unlikely, terrorist use of biological materials as weapons skews resources to unique military and counterterrorism measures and away from measures that are useful in both events. In the post-pandemic period, governments need to rebalance their efforts. Rand Corporation
SELECT AGENTS + PRIORITY PATHOGENS
Potential Threats to Human Health from Eurasian Avian-Like Swine Influenza A(H1N1) Virus and Its Reassortants
During 2018–2020, we isolated 32 Eurasian avian-like swine influenza A(H1N1) viruses and their reassortant viruses from pigs in China. Genomic testing identified a novel reassortant H3N1 virus, which emerged in late 2020. Derived from G4 Eurasian H1N1 and H3N2 swine influenza viruses. This virus poses a risk for zoonotic infection. Emerging Infectious Diseases
Nipah Virus Detection at Bat Roosts after Spillover Events, Bangladesh, 2012–2019
Knowledge of the dynamics and genetic diversity of Nipah virus circulating in bats and at the human-animal interface is limited by current sampling efforts, which produce few detections of viral RNA. We report a series of investigations at Pteropus medius bat roosts identified near the locations of human Nipah cases in Bangladesh. Emerging Infectious Diseases
Monkeypox Outbreak in the United States — May 2022
Since the 17 May initiation of a CDC Health Alert Network (HAN) Health Advisory, confirmed cases have been reported by nine states. In addition, 28 countries and territories, none of which has endemic monkeypox, have reported laboratory-confirmed cases. On May 19, a call center was established to provide guidance to states for the evaluation of possible cases of monkeypox, including recommendations for clinical diagnosis and orthopoxvirus testing. The call center also gathers information about possible cases to identify interjurisdictional linkages. On May 23, an incident command structure was created within CDC’s National Center for Emerging and Zoonotic Infectious Diseases to respond to this outbreak. As of May 31, nine states (California, Colorado, Florida, Georgia, Massachusetts, New York, Utah, Virginia, and Washington) have reported 17 patients with confirmed orthopoxvirus infections. Most cases (16) were diagnosed in persons who identify as gay, bisexual, or men who have sex with men (MSM). Fourteen patients of the 17 patients reported international travel involving 11 different countries during the 21 days preceding symptom onset.
In addition to skin rash, patients commonly reported chills (12) fatigue or malaise (11), and lymphadenopathy (nine); fever was reported in seven patients. Twelve patients reported prodromal symptoms before rash onset such as fatigue, fever, or headache. Among eight patients, the rash started in the genital or perianal area. All but one patient developed a disseminated rash, occurring on the arms, trunk, legs, and face. CDC MMWR
Monkeypox: Governments are Scrambling for a Limited Pool of Vaccines and Treatments with Unclear Effectiveness
In theory, at least two drugs and two types of vaccines are available to combat a monkeypox outbreak, but most of these have been tested primarily in animals. So far, health officials have delivered about 1,200 vaccine doses and 100 treatment courses to eight states, according to Dr. Raj Panjabi, the White House’s senior director for global health security and biodefense. In a recent study of the two drugs in seven patients, only one appeared to offer any benefit, while the other produced toxic side effects.
The older of the two vaccine options was used to eradicate smallpox and can cause harsh side effects, including heart problems and death. Most doses have been in storage for decades and may have lost their effectiveness. The second vaccine option, made by the Danish company Bavarian Nordic, was approved by the FDA in 2019 to prevent smallpox and monkeypox. Called Jynneos in the United States, it is safer than earlier vaccines, but supplies are even more limited. Several experts noted that African countries that have battled monkeypox for years have had little to no access to these vaccines and treatments. NY Times
Monkeypox Outbreaks Outside Endemic Regions: Scientific and Social Priorities
In nature, the monkeypox virus transmits to humans from either rodents or from infected humans. Hundreds of cases of human monkeypox are detected in west and central Africa annually. The few cases seen outside Africa have all been associated with travel to Africa or contact with imported infected rodents. The role of rodents in the UK monkeypox cases with history of travel to Africa might reflect the current wave of human monkeypox infections occurring in Nigeria consequential to increased exposures to rodents during the COVID-19 lockdown periods. These secondary epidemiological cycles with human-to-human spread might be affecting international travelers. Further study on rodent dynamics and monkeypox cases inside and outside endemic regions aligned to viral genomics is required to detect possible drivers for the current monkeypox epidemic. The Lancet Infectious Diseases
Risk Factors for Ebola Virus Persistence in Semen of Survivors – Liberia
This study was designed to understand how the acute course of EVD, convalescence, and host immune and genetic factors may play a role in prolonged viral persistence in semen. Older age, decreased illness severity, elevated total serum IgG3 and HLA-C*03:04 allele expression may be risk factors for the persistence of EBOV in the semen of EVD survivors. EBOV persistence in semen may also be associated with its persistence in other immunologically protected sites, such as the eye. Clinical Infectious Diseases
The Lanzhou Brucella Leak: The Largest Laboratory Accident in the History of Infectious Diseases?
An inadequacy in sanitizing processes in a biopharmaceutical plant in Lanzhou, China, during July and August 2019, led to the aerosolization of Brucella that was subsequently spread through wind in nearby settlements and academic institutes, resulting in more than 10,000 human brucellosis cases, as of November 2020. The leak, possibly the largest laboratory accident in the history of infectious diseases, underlines the particular characteristics of Brucella that have made the pathogen a historical entity in biodefense research and a major cause of laboratory-associated infections. It further underlines the need for enhanced vigilance and strict regulatory interventions in similar facilities. Clinical Infectious Diseases
CHEMICAL + RADIOLOGICAL THREATS
Emergency Management Experts in West Africa Enhance Chemical Incident Response Skills
OPCW Assistance and Protection Branch hosted a regional table-top exercise on Chemical Incident Emergency Response (TTX-22) for countries that are members of the Economic Community of West African States (ECOWAS) in Abidjan, Côte d’Ivoire from 24 to 26 May 2022. OPCW
Nuclear and Radiological Emergencies: Biological Effects, Countermeasures and Biodosimetry
Potential countermeasures according to a specific scenario require considering basic issues, e.g., the type of radiation, people directly affected and first responders, range of doses received and whether the exposure or contamination has affected the total body or is partial. This review focuses on available medical countermeasures (radioprotectors, radiomitigators, radionuclide scavengers), biodosimetry, and strategies to implement the response to an accidental radiation exposure. In the case of large‐scale atomic or radiological events, the most ideal choice for triage, dose assessment and victim classification, is the utilization of global biodosimetry networks, in combination with the automation of strategies based on modular platforms. Antioxidants
SURVEILLANCE + DETECTION
CDC Inks MOU for Diagnostic Surge Testing Capacity for Public Health Emergencies
In May, the FDA, CDC and several stakeholders (including APHL, CSTE, AdvaMed, and ACLA) signed a Memorandum of Understanding to collaborate on enhancing laboratory testing surge capacity outside of CDC and public health laboratories before and during public health emergencies. As clearly evidenced during the COVID-19 pandemic, partnerships and engagement between the public and private sector are crucial to supporting a significant increase in demand for diagnostic testing during a public health emergency and to respond to emerging public health threats. FDA
An Early Warning System for Emerging SARS-CoV-2 Variants
In June 2020, the World Health Organization (WHO) SARS-CoV-2 evolution working group was established to track SARS-CoV-2 variants and their specific genetic changes and to monitor viral characteristics and their impact on medical and non-medical countermeasures, including vaccines against COVID-19. In November 2021, this working group transitioned to a formal WHO Technical Advisory Group on Virus Evolution (TAG-VE), with the aim of developing and implementing a global risk-monitoring framework for SARS-CoV-2 variants, based on a multidisciplinary approach that includes in silico, virological, clinical and epidemiological data. Nature Medicine
Trends in Acute Hepatitis of Unspecified Etiology and Adenovirus Stool Testing Results in Children — United States, 2017–2022
Following identification of pediatric hepatitis cases of unknown etiology in the United States and the United Kingdom, CDC issued a request in April 2022 for U.S. providers to report additional cases. Many reported cases had test results positive for adenovirus, which is not known to cause hepatitis in immunocompetent children. Analyses of four large data sources did not indicate recent increases in hepatitis-associated emergency department visits or hospitalizations, liver transplants, or adenovirus types 40/41 percent positivity among U.S. children compared with pre–COVID-19 pandemic levels; continued surveillance is important to monitor changes over time. CDC MMWR
Implementing a DHIS2 Ebola Virus Disease Module During the 2021 Guinea Ebola Outbreak
During 2019, the Guinea started using DHIS2 Tracker to collect case-based data for epidemic-prone diseases. In 2020, the capability was expanded, and it was used during the COVID-19 pandemic to capture data relevant to the COVID-19 response. When an Ebola virus disease (EVD) outbreak was announced in February 2021, the Tracker module was updated, and enhanced functionalities were developed to meet the needs for the emerging epidemic. This novel EVD module has components to capture information on cases, contacts, alerts, laboratory and vaccinations and provides a centralized site for all EVD outbreak data. It has since been expanded for use with future viral haemorrhagic fever outbreaks.
The effort is not without challenges. Although one of the primary objectives was to create a centralized repository for all outbreak data, duplicate databases with the same information persisted. Training, equipment access and familiarity barriers resulted in not everyone being able to access to the EVD module or endeavoring to use it. For example, parallel line lists for vaccination and surveillance contacts were created and maintained resulting in duplicative efforts and questions around the validity of both lists. Information did not match or was incomplete in one source or the other causing delays in presenting timely data as verification between sources was conducted. Concerns around data quality attributes of completeness and timeliness also existed. BMJ Global Health
The Pig as an Amplifying Host for New and Emerging Zoonotic Viruses
This review discusses the role that pigs play as intermediate/amplifying hosts for zoonotic viruses with pandemic potential and consider how multivalent vaccination of pigs could in turn safeguard human health. Expansion and intensification of pig production has resulted in significant changes to traditional pig husbandry practices leading to an environment conducive to increased emergence and spread of infectious diseases. These include a number of zoonotic viruses including influenza, Japanese encephalitis, Nipah and coronaviruses. Pigs are known to independently facilitate the creation of novel reassortant influenza A virus strains, capable of causing pandemics. Moreover, pigs play a role in the amplification of Japanese encephalitis virus, transmitted by mosquito vectors found in areas inhabited by over half the world’s human population. Furthermore, pigs acted as an amplifying host in the first and still most severe outbreak of Nipah virus in Malaysia, that necessitated the culling over 1 million pigs. Finally, novel porcine coronaviruses are being discovered in high pig-density countries which have pandemic potential. One Health
PUBLIC HEALTH
“Long COVID” Results After Hospitalization for SARS-CoV-2 Infection
The few published prospective studies using a 12-month timepoint providing an overview of the clinical symptoms and quality of life of adult patients show that, although decreasing over time, a meaningful portion of patients still report persistent symptoms one year after infection20,22,23,24,25. Overall, our findings are in line with such results, although with a lower proportion of patients experiencing persistent symptoms, with a meaningful proportion of patients of experiencing dyspnea and patterns of neurologic symptoms. Clinical impairment can persist at least until one year after COVID-19 symptom onset and reduce patients’ quality of life significantly. At both 6 and 12 months, general and neurocognitive symptoms were markedly more common in patients who had been treated with non-invasive or invasive mechanical ventilation during hospitalization. Furthermore, patients who received tracheal intubation, HFNC, or NIV had a significantly higher risk of developing dyspnea at 6 months than those who received no therapy or low-flow oxygen. Scientific Reports
The Irony — and Ignominy — of Medical Conferences as Superspreader Events
The Society for Academic Emergency Medicine (SAEM), a large medical organization, held its annual meeting in person in New Orleans after canceling the event in 2020 and holding it virtually in 2021. With cases and hospitalizations rising in many parts of the country, including New Orleans, and a community vaccination rate of around 50% for the host city, attending a large, multi-day, indoor meeting with after-hours socializing in the community posed numerous safety risks. In fact, a computing conference held in New Orleans the prior week was under scrutiny as a high transmission event. Yet the SAEM’s Covid policy was not modified to reflect contemporaneous public health data. Nor did the organizers implement a vaccine verification system, require boosters, or incorporate a Covid-19 testing strategy. Masks were “welcome” but optional. No information was provided about ventilation and there were no efforts to minimize indoor crowding. No standards were suggested about minimizing spread in social gatherings. The outcome was predictable. STAT
Monkeypox Offers New Cause for Contact Tracing
With 31 monkeypox cases confirmed in 12 states and the District of Columbia and growing concern about community spread, federal and state public health officials are turning to a frayed page in the pandemic playbook: Using contact tracing to track exposure risk. Why it matters: Contact tracing proved an ineffective tool for an airborne virus like COVID-19 with a short incubation period, but monkeypox is different. Axios
HISTORICAL REFLECTIONS
US Military Smallpox Vaccination Program Experience (2003)
In December 2002, the United States implemented a program of Dryvax smallpox vaccinations with for approximately 500,000 military personnel. The directive came as part of a national program of preparedness against biological attack. In 5.5 months (from Dec 2002 – May 2003) the DoD administered 450,293 smallpox vaccinations (70.5% primary vaccinees and 29.5% revaccinees). In 2 settings, 0.5% and 3.0% of vaccine recipients needed short-term sick leave. Most adverse events occurred at rates below historical rates. One case of encephalitis and 37 cases of acute myopericarditis developed after vaccination; all cases recovered. Among 19,461 worker-months of clinical contact, there were no cases of transmission of vaccinia from worker to patient, no cases of eczema vaccinatum or progressive vaccinia, and no attributed deaths. JAMA
CDC Retires One Old Smallpox Vaccine, Keeps Another (2008)
Federal health officials recently announced plans to get rid of their last remaining stocks of the decades-old smallpox vaccine Dryvax, as a newer vaccine takes its place in the national stockpile of emergency medical supplies. Dryvax, which was made by Wyeth Pharmaceuticals and whose active ingredient is vaccinia virus grown on the skin of calves, is being replaced by ACAM2000, made by Acambis and grown in laboratory cell cultures. However, the national stockpile still contains, as a backup, hundreds of millions of doses of another old smallpox vaccine similar to Dryvax, according to the CDC. As of Feb 11 (2008), the SNS contained 195.2 million doses of ACAM2000 and 425 million doses of an older smallpox vaccine made by Aventis Pasteur (now Sanofi Pasteur). The Aventis vaccine was made before smallpox vaccination in the U.S. ended in the early 1970s, according to online information from the FDA. In 2002 Aventis Pasteur revealed it had between 75 million and 90 million doses of smallpox vaccine in storage and was turning the whole amount over to the government. Later that year, Health and Human Services (HHS) Secretary Tommy Thompson said the Aventis vaccine totaled 85 million doses and could be diluted to yield five to ten times as many. CIDRAP
Mystery of Black Death’s Origins Solved, Say Researchers
Researchers believe they have solved the nearly 700-year-old mystery of the origins of the Black Death, the deadliest pandemic in recorded history, which swept through Europe, Asia and north Africa in the mid-14th century. International team link spike in deaths at cemeteries in Kyrgyzstan in 1300s to start of plague pandemic. At least tens of millions of people died when bubonic plague tore across the continents, probably by spreading along trade routes. Despite intense efforts to uncover the source of the outbreak, the lack of firm evidence had left the question open. The Guardian
SPECIAL INTEREST
Joining the National Disaster Medical System
NDMS teams are organized and trained groups of professionals who help devastated communities by providing emergency medical care; staffing medical shelters or medical stations; augmenting hospital staff; providing veterinary care; conducting disaster mortuary operations; managing logistics; synthesizing data; and more. NDMS responders serve on an intermittent basis. Similar to military reservists, NDMS personnel come from private sector jobs around the country to respond as intermittent federal employees during disasters. Before becoming a part of the team, you need to apply for the job. NDMS advertises and accepts applications for team positions on USAJOBS. HHS/ASPR
New York Fund to Publicly Apologize for its Role in Tuskegee Syphilis Study
Fifty years after the infamous Tuskegee syphilis study was revealed and halted, an organization that made funeral payments which facilitated the study, the Milbank Memorial Fund, has issued an apology and undisclosed donation for scholarships to descendants. The deception and injury caused by the racist study left an enduring legacy of distrust of the medical establishment. The Guardian
Also Reading:
Risk of myocarditis and pericarditis after the COVID-19 mRNA vaccination in the USA: a cohort study in claims databases. The Lancet
Immuno-epidemiology and the predictability of viral evolution. Science
Antibody escape of SARS-CoV-2 Omicron BA.4 and BA.5 from vaccine and BA.1 serum. Cell
As monkeypox threat grows, scientists debate best vaccine strategy. Science
Investigation into monkeypox outbreak in England: technical briefing 1 Gov.UK
Highly Pathogenic Avian Influenza A(H5N8) Clade 2.3.4.4b Virus in Dust Samples from Poultry Farms, France, 2021 Emerging Infectious Diseases
Discovery of novel DNA viruses in small mammals from Kenya. Virologica Sinica